. Bath time is often extremely distressing to older nursing home residents with dementia, leading to aggression and other disruptive behaviors. Encountering these behaviors is distressing for nursing home staff who feel not only obligated to maintain hygiene, but also frustrated, when their assistance engenders resistance. This project will evaluate the effectiveness of two interventions, psychosocial training only and psychosocial training with use of the towel bath (an in-bed bathing method), by comparing them with standard nursing home bathing practices. This collaborative effort by the two research teams active in this area, builds upon NIA-supported preliminary studies that: 1) developed measures of resident disruptive behavior, task completion, and caregiver behavior during bathing, using videotape data and blinded raters; 2) developed and pilot tested a psychosocial intervention with nursing home caregivers; and 3) identified the towel bath to be a promising method for improving comfort and reducing agitation in residents with dementia. The design is a randomized clinical study with crossover, in which the nursing home is the unit of randomization and of primary analysis. Three groups of 5 nursing homes each, with 4 subjects in each home, will be compared. Two groups (10 homes) will receive standard care (no intervention). Study subjects will be severely or moderately cognitively impaired residents who have demonstrated a high level of disruptive behavior during routine bath care using traditional bathing methods. Outcomes of interest include: reduction in the frequency, duration, and intensity of disruptive behaviors; comparable skin condition; similar rates of colonization by bacteria and Candida albicans, known to cause disease and/or odor; and improvement in caregiver outcomes. The study sample will include adequate representation of African-Americans and subjects of both genders. If alternative bathing approaches methods can be demonstrated to provide a more satisfying and equally hygienic experience for nursing home residents with dementia and disruptive behaviors, then wider application in long-term care would help extend the OBRA mandate for resident-centered care to this important activity of daily living (ADL).